Monday, June 15, 2009

Are you an Ungrateful Patient?

This week, the American Medical Association voted in favor of Resolution 710, an attempt to identify patients who are "abusive, hostile, or non-compliant."

I come from a family of medical doctors and nurses - my parents, my grandfathers on both sides, numerous cousins, and an extended family, all of whom could staff a large community hospital with all specialties. I appreciate doctors and the fact that, for many, practicing the healing science of medicine the way they dreamed of when they were students is simply not possible with our current system of medical malpractice and liability.

And so, if this resolution were about liability, I could probably understand it. In this litigious culture, it seems reasonable that doctors should have the ability to indicate simply that a patient has not complied with suggested care, and therefore the doctor is not responsible for the negative outcome that ensued.

But the introduction of the resolution is not about liability, and it certainly isn't about improving patient care or outcomes. The resolution is suggested because patients "are becoming more abusive and hostile toward physicians," and have "unreasonable expectations and demands," which includes "instantaneous cure," due to the "arrogance and/or the belief that they 'own' their physicians." The resolution further states that "the stress of dealing with ungrateful patients is adding to the stress of physicians, leading to decreased physician satisfaction." This isn't about an MD protecting him or herself from a malpractice lawsuit. This is about doctors made cranky because their patients are demanding to be collaborators in their own care. It is as simple as that.

But what's not simple are the implications. In maternity care, women who want to be supported in a low-intervention birth can indeed be identified as non-compliant, particularly when women have very little choice but to give birth in a hospital that sees childbirth as a medical malpractice suit waiting to happen. A healthy pregnant woman who wants to give birth safely and with minimal medical care is not asking for an "instantaneous cure." In fact, what she is asking for is time -- a whole lot of it -- so that her baby can descend into the pelvis as it is physiologically programmed to, and so that she can experience the sensations - yes, the pain! - of healthy, normal childbirth without the pressure of liability-based policies rushing her and quite possibly altering her body and her ability to give birth in a physiologically normal way ever again. I appreciate that doctors face malpractice threats that can indeed ruin their careers and their quality of life, if not their children's lives, but birthing women are a part of this same system, and we are fighting for our lives, too. We don't want to "own" our physicians, but we want recognition that we do own our own bodies, and that we cannot be subjected to unwanted medical procedures that are not based in sound evidence and do not increase the chance of a healthy outcome.

The implications go beyond maternity care. If an MD in any area of medicine identifies a non-compliant patient to a health insurance company, can that insurance company refuse coverage of a non-compliant patient?

Just who, in fact, does this resolution serve? Will it result in greater doctor-patient relationships? Will it create better "job satisfaction" for physicians? It will only create more sick people who are ineligible for care. And that will not increase anyone's satisfaction at all.


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